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World J Gastroenterol. Oct 7, 2014; 20(37): 13369-13381
Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13369
Laparoscopic liver resection: Wedge resections to living donor hepatectomy, are we heading in the right direction?
P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Gadiyaram Srikanth, Baiju Senadhipan, Mohamad S Rela
P Thomas Cherian, Ashish Kumar Mishra, Palaniappen Kumar, Vijayant Kumar Sachan, Anand Bharathan, Mohamad S Rela, Department of HPB Surgery and Liver Transplantation, Global Hospital, Hyderabad 500004, India
Gadiyaram Srikanth, Department of Gastro-intestinal Surgery, BGS-Global Hospital, Kengeri, Bangalore 560060, India
Baiju Senadhipan, Department of Gastro-intestinal Surgery, SUT-Royal Hospital, Ulloor, Trivandrum 695011, Kerala, India
Author contributions: Cherian PT designed the study, analyzed literature, and prepared the manuscript; Mishra AK, Kumar P and Sachan VK conducted subject research and aided manuscript preparation; Bharathan A, Srikanth G and Senadhipan B reviewed the reports and performed revisions to the manuscript; Rela MS completed final revision of the Manuscript.
Correspondence to: P Thomas Cherian, MBBS, FRCS, FRCS, CCST, Head, Department of HPB Surgery and Liver Transplantation, Global Hospital, 6-1-1070 Lakdi-ka-pool, Hyderabad 500004, India. liversurg@live.co.uk
Telephone: +91-97-04777700 Fax: +91-40-23244455
Received: March 7, 2014
Revised: May 3, 2014
Accepted: July 15, 2014
Published online: October 7, 2014
Processing time: 214 Days and 5.5 Hours
Abstract

Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection (OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have divided this review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection (LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy (LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service.

Keywords: Liver; Laparoscopic; Transplantation; Resection; Living donor; Minimally invasive; Technique; Hepatocellular; Hepatectomy; Cirrhosis

Core tip: Given that a liver resection is ideally suited for a laparoscopic approach (no anastomosis, very large incision in open approach) there is increasing interest in the technique worldwide. However actual experience is limited to a few centres, and guidelines remain inadequate. This article summarises the current available evidence on the significant aspects of the technique individually, to guide clinicians considering developing such a practice.